Healthcare Provider Details

I. General information

NPI: 1710019369
Provider Name (Legal Business Name): SUSANNE PELLEY MARTIN HERZ MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 CLAREMONT AVE
OAKLAND CA
94618-1033
US

IV. Provider business mailing address

5220 CLAREMONT AVE
OAKLAND CA
94618-1033
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3226
  • Fax:
Mailing address:
  • Phone: 510-428-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA93776
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: